TTC with Complete Septate Uterus

I am fairly new around here, and looking for some ladies to share my story with and also probably to vent some frustrations and obsess a little bit too (my poor hubby gets a bit sick of me overthinking things I think!)

We have really only just started TTC in the last month or so. I was on the contraceptive pill before, took my last pill on Dec 7th and had the usual withdrawal bleeding from Dec 11 to Dec 15. I have just started my first real period since then after a 41 day cycle, so thats positive in the sense that everything seems to be working ok...

Just to throw a spanner in the works, I have also been recently diagnosed (picked up on a pre-conception examination) with complete septate uterus. ie. a complete division of the uterus, two cervical canals and "double vagina". I have been referred to a specialist at a major womens hospital in my hometown but apparently they will not be able to see me until april or may this year (the referral was made in October so I think that is a bit ridiculous but there is not much I can do about it...)

I have had to have a couple of gynae ultrasounds which is all they have used for diagnosis so far. They also found a single cyst on my left ovary (which was still there 2 months after the first scan). The lady that did my scans is actually an ob/gyn and she told me that the risk of miscarriage with COMPLETE septate uterus (ie. divided from the top of the uterus, right through into the vagina) is generally less than those with a PARTIAL septum. And also that the need for surgery was generally not as great in complete septate. Has anyone else ever heard that before?

She also said it appears that I'm more "right-side dominant" which I think means that the right side of the vagina is more dominant (mostly cos thats where the trans-vaginal ultrsound probe automatically went) so when I do get pregnant it will likely be carried in the right side. I am not sure however if the right side of the uterus is any different in size to the left, or which cervix looks better.

It is a bit difficult at the moment because having not had a consultation with a specialist yet, I am trying to piece together bits and pieces of information from the ultrasound ob/gyn, my GP and what little information is available online (and also anecdotal stuff from you lovely ladies here!) My husband and I have decided for now to continue TTC just to see what my body can do...I would prefer to avoid surgery if at all possible! And if I can turn up at the appointment with a few months of TTC (and maybe even a BFP! wishful thinking....) under my belt, then all the better ;-)

I would love to hear from any of you ladies if you have any advice, or experiences with a similar diagnosis (the good the bad and the ugly!) The stories make coming to terms with the diagnosis so much easier!

Oh, also, does anyone have a good explanation for how they differentiate between complete septate and uterus didelphys? The seem very similar to me and sounds like they both can be misdiagnosed as the other quite easily. Just curious (I have a medical background and finding it all a bit interesting...lol!)

Comments (17)

In uterus didelphys, you have two completely independent uteri and cervices. In a complete septate uterus, the exterior of your uterus is normal - it just looks like one uterus. The septum divides the interior of the uterus and cervix. In uterus bicornis bicollis, the exterior of the uterus looks like a heart or bunny ears and a single cervix is divided with a septum.

So you need to have a good view of the exterior of the uterus and the anatomy of the cervix/cervices to determine which of the three scenarios you fall into. MRI, laparoscopy, or 3D ultrasound can be used... but you're right - misdiagnosis is very common. Concurrent laparoscopy/hysteroscopy is the gold standard for diagnosing uterine anomalies.

As for miscarriage rates... no, I don't think that they are lower with a complete septum. Some women with a septate uterus appear to have a ~90% miscarriage rate while others have a miscarriage rate that is only slightly elevated. There really doesn't appear to be any rhyme or reason.

My septum was not complete, but it extended most of the way through my uterus.I had my septum removed after my son was born at 27 weeks due to preterm labor. I'll be honest: the surgery was super easy, especially after experiencing 2 first trimester losses and a 2.5-month NICU stay. It was super cheap, too, compared to the NICU stay, which cost $538,000. Recovering from the surgery took a couple days. My son has been very healthy for a 27-weeker, but his prematurity will have lifelong implications.

Another thing to think about is the high probablility of breech presentation associated with uterine anomalies. Would you rather have a septum resection or a cesarean delivery? That's a very personal decision, but personally, I'm much more comfortable allowing a doctor to cut through a non-functional septum than allowing him to cut through functional uterine muscle. Your risk for uterine rupture only really increases when you have a history of uterine surgeries that cut through your uterine muscle. Of course, it's possible to have a completely normal pregnancy with an intact septum, but I think it's worthwhile to do everything you can to put the odds in your favor before getting pregnant. (Hard lesson learned in my case.)

I have a compete septate, but I had the vaginal portion removed because we hoped it works make sex more comfortable (it didn't) and so we didn't have to worry about having sex on each side since I had no idea which side would be ovulating.

My personal miscarriage rate has been 50 percent. Live birth, then a 4.5week "chemical pregnancy." my current pregnancy started as twins but one twin stopped developing around 5 weeks. I'm 12.5 weeks now, the surviving twin is doing fine.

If I were you I would not be TTC until I spoke to a specialist. Your m/c rates are very high and pregnancy related issues are as well. Just because you are bigger on the right doesn't mean you will carry there. You could carry on the left and run into major problems if its too small. I had my septate which was complete top to bottom (but 1 cervix) removed. It was a simple procedure. I was very lucky ihad that done since I sitll went into preterm labor at 24 weeks. If it was resected god knows what could have been. Your goal is to get preg and carry a healthy baby full term- I would want to increase my chances of that.

Thank you for your stories and advice! It is really helpful to hear the stories of others - it gives some reality to all the facts and diagnosis :-)

Kristen Lena - thanks for the explanation about sepate vs. didelphys. I am guessing that I will be given (or will be asking for!) an MRI for a true diagnosis and a more detailed explanation of my anatomy - as I said before, I have only been diagnosed by trans-vaginal/abdo ultrasound so not too sure how clear their view on the outside surfaces of the uterus was. I had to have a repeat scan because it was difficult to visualise the first time around and initially the ob/gyn said didelphys, and then changed her mind and said septate, thus my curiosity! I have heard that the surgery is fairly straight-forward, glad it has all gone well for you! My ob/gyn had mentioned the risk of damaging the cervix when removing a complete septum, and because of the size/length of the septum, that the scar tissue could also cause problems with fertility, and pretty much told me they wouldn't recommend surgery for me unless/until the septum was causing issues with carrying a pregnancy. Obviously I need to speak with the specialist about the risks and benefits, and I think it will be a big decision to make either way!

Also, if you don't mind me asking, did you have the diagnosis of septate before your pregnancy, and if so, did they do extra scans and cervical measurements? I am sorry about your pre-term delivery (I work in neonates, so have met a lot of people that have similar stories!) - it is a very difficult thing to go through, but I am glad to hear that your little one is doing well :-) A real little cutie-pie judging by the pics in your signature!

pindichic - wishing you all the best with the current pregnancy! I am sorry to hear about your losses, but thank you for sharing your experiences! If you don't mind me asking, did you carry your first bubba to term and/or did you experience any complications related to the septate during your pregnancy? Also, did you ever consider having them septum surgically removed and if so, what were your reasons not to?

michelle0677 - yep, I am absolutely dying to get to that appointment with the specialist! Our decision to continue TTC right now has not been made lightly, and my husband and I have made that decision in consideration of all of the risks that have been explained to us, and that we have researched ourselves. Maybe it is because I work in the healthcare system that my inclination is to avoid intervention until I can prove to myself that it is completely necessary. Also, just to clarify, the doctor said that my right side was more dominant, purely because the vaginal opening on that side is bigger and therefore when we have intercourse, it tends to be (I would say 99.9% of the time!) on the right side, therefore it would follow that I would be likely to get pregnant on that side. There has never been any mention of one side of the uterus being bigger or 'better' than the other at this stage.

I am sorry to hear about your pre-term labour - I hope that you have seen all the best outcomes after that! Hope this is not too personal, but do they think that the pre-term labour was related at all to the septum being there previously, or some other unrelated reason?

Anyway, thanks again ladies for sharing! I really appreciate your stories and advice!

We had trouble TTC my first (due to hormonal issues, not uterine-related), and I was diagnosed with didelphys then via MRI. Later, during my 2nd c/s, my dr is almost certain that it's complete septate instead. Since by then I had had 2 healthy albeit early children, I haven't even considered surgery. I also have a double cervix and a vaginal septum (that I left in place because it's never caused me any problems).

My personal miscarriage rate is 0%. I have a 4yo, 2yo, and am 26 weeks pg with #3. I had an incompetent cervix with #1, so I have gotten cerclages with all 3 pg. My 2 boys were about a month and a half early due to ptl (#1) and low fluid (#2), so I'm just waiting to see how long I can make it this time.

While TTC my first, I was told that my left side was dominant (similar reasons as you), so the IUIs were all aimed in the left uterus. Since then, I've gotten pg twice the old fashioned way in the right uterus. As it turns out, the right seems to grow bigger babies.

I'd take any predictions the drs give you as only possibilities. You never really know how your body will handle pregnancy until it does. Good luck!

The way my dr explained my issues with pre term labor and irritable uterus was - a septated uterus is one that didn't complete the formation in uturo and they believe that eventhough i have 1 cervix that it is weakend due to it just not being 100% complete. If that makes sense. So they say i have a weaken cervix and my uterus is irritable from also not fully being able to form completely. I have gone through further testing before ttc #2 to see if there was anything I could do to prevent PTL and short cervix. They said no... they can't say for sure if my cervix is weak or if my uterus was just not able to stretch as fast and as much as it needed to which put pressure on my cervix. THey told me chances are i will be on bed rest again next time around.

You and your DH know your situation best and you know the pros and cons of TTC vs waiting. That is what is important.

I only knew that a had some sort of bifid uterus - probably septate or bicornuate. It caused a lot of trouble during my first miscarriage - my D&C was unsuccessful (after 3 OB/GYNs tried for 3 hours to remove the products of conception), so the miscarriage had to be induced. I meant to have an SHG done to get a more clear diagnosis, but I got pregnant first.

I did not have extra monitoring with my last pregnancy other than a high-resolution ultrasound at 7 weeks. I've been through the "what-ifs" many times, but in the end, I have to agree with my MFM's conclusion - having extra monitoring during that pregnancy probably wouldn't have changed the outcome. I went to L&D at the very start of my preterm labor symptoms, and my cervix was closed at that point. I don't know the length, but the resident who checked me didn't seen to think I was effaced. Couple hours later, I was 1 cm dilated and 50% effaced. My labor was stalled at less than 2 cm dilated and 75% effaced. Everyone seemed optimistic that I could be discharged after getting my second betamethasone shot. And then I had a precipitous labor... my son came sliding out feet-first 5 minutes after I got that second shot. As much as we like to have faith in modern medicine, there aren't any interventions that can stop labor when your body is that determined to deliver a baby. The only thing that maybe could have helped was progesterone/17P shots, but they're not indicated for women who don't have a history of spontaneous preterm delivery. We'll see whether they help me out next time around....

As for complete septums - my understanding is that in the hands of an experienced surgeon, their resection is generally not a problem. There are techniques for dealing with the cervix, and scarring should be minimal if the procedure is done well (unless the woman is genetically predisposed to developing adhesions).

I have a complete septate with one cervix and one vagina and have had two pregnancies that I know of. I never kept track of my cycles so it is possible I had a chemical pregnancy and just didn't know it. Both my kids were preemies the first at 33 weeks and the second at 34 weeks. With both pregnancies I had tons of monitoring by a MFM and a regular OB and bedrest. TV u/s every 10-14 days by my MFM and visits biweekly with my regular OB. With the second I had a cerclage and 17P injections. My doctors were very much on top of my pregnancies. I did not have the resection due to some previous medical issues and on the advice of my MFM and regular OB who saw it up close and personal during my c/s.

No one will be able to tell you how your body will respond to pregnancy until it happens. Is it possible that with our condition that someone can carry to term? Yes. Is it possible that there could be serious complications, you could miscarry, you could deliver early and the baby could have serious health issues? Yes

For me it has been proven twice that I cannot carry to term. Even with medical intervention. Do I regret my decision to not have the surgery? No. For me it just wasn't an option but I am probably in the minority. Keep us up dated on your appointment with your specialist. Make sure you ask tons of questions and be sure to ask how much experience they have with mullerian anomolies. How much monitoring they will do, what kind of plan will they map out for you. I'm sure the ladies here will help out with what to ask about surgery options and further testing you might need.

My son was full-term, no problems at all. My ob that diagnosed my septum felt that the statistics weren't reliable so we decided to see what happened. And there's still no reason to think my mc was anything other than a really common chemical pregnancy. As for thus lost twin, we know where the sac was, it was nowhere near the septum, so we believe it was unrelated to the septum as well.

Everyone's experiences here are so different and it is great to hear all of the positives and negatives - there have been a couple of things that I had never come across or thought about before so thinking of lots of questions....on that note, I have FINALLY got an appointment with the specialist for the first week in March.

This might sound strange but I am kind of terrified but also kind of excited at the same time to figure out which way this journey is going to go.